Are Americans Really the Worst Patients?

A recent article was published in the Atlantic about Americans being the worst patients.



Americans are part of a broken and dysfunctional health care system with exorbitant costs, a maelstrom of bureaucratic red tape, and insurance coverage that barely covers what most people need.

But are they contributing to this system by being such bad patients?

The article in the Atlantic seems to imply that this is the case. The unwillingness of Americans to comply with doctor’s orders, take responsibility for their own health and medications, and their inability to accept the inevitability of dying has led to exorbitant health care costs. It also mentioned the highly expensive, and often unnecessary and futile treatment demanded by Americans.

I remember my early forays into American medicine. I had started my residency training at an extremely busy university hospital in Philadelphia. As a new immigrant doctor, I remember thinking that there was so much overtesting and overtreating here, especially at the end of life.

In addition, patients kept coming back without making any personal effort to improve on their own health. They again underwent repeat testing and procedures.

I greatly admired the immense value placed on each individual human life but could not always understand the aggressiveness of care, especially in futile and terminal circumstances. In contrast, there was, and still is, so little emphasis on the prevention of diseases other than periodic cancer screenings and vaccinations. Patients that are non-adherent to treatment still show up expecting you to fix them, only to have them bounce back again.

The corporatization of health care has also rendered the patient as a mere customer, and all aberrant behavior has to be tolerated. Treating patients as customers makes it harder to decline demands for pain meds and unnecessary antibiotics. This has led to overtreatment of pain, and in no small way, to the current opioid crisis.

Doctors also don’t have enough allotted time to talk about diet and other lifestyle modifications in the era of EMRs and 15-minute follow-ups, In addition, addressing health issues such as obesity early on can be viewed as fat shaming.

The threat of lawsuits and the fear of bad patient reviews often influences decision making.

So how could we all be better patients?

An important step would be to rebuild the doctor-patient relationship. We need to re-establish trust in physicians as the leader of the health care team. Studies have shown that building trust and having a good patient-doctor experience can go a long way in ensuring compliance, follow up, and producing better outcomes. Malpractice policies and tort reform have to be better addressed if full trust is to be regained.

Social disparities and health care inequities also play a big role in patient adherence to treatment and the ability to make lifestyle modifications.

With obesity reaching epidemic proportions and being a root cause of many other costly and debilitating diseases, these are important considerations.

Government policies such as adequate and paid maternity/paternity leave, good maternal health, and childcare, can also play a big role in giving families tools to improve their health right from the start. Hospital systems, along with physicians, can also do more to promote community initiatives that focus on disease prevention.

So yes, I do agree that Americans probably are the worst patients. But, it is not all their fault.

In many ways, the system has failed them too.

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